title: Economic evaluation of Chagas disease screening of pregnant Latin American women and of their infants in a non endemic area.
abstract: Migration is a channel through which Chagas disease is imported, and vertical transmission is a channel through which the disease is spread in non-endemic countries. This study presents the economic evaluation of Chagas disease screening in pregnant women from Latin America and in their newborns in a non endemic area such as Spain. The economic impact of Chagas disease screening is tested through two decision models, one for the newborn and one for the mother, against the alternative hypothesis of no screening for either the newborn or the mother. Results show that the option "no test" is dominated by the option "test". The cost effectiveness ratio in the "newborn model" was 22€/QALYs gained in the case of screening and 125€/QALYs gained in the case of no screening. The cost effectiveness ratio in the "mother model" was 96€/QALYs gained in the case of screening and 1675€/QALYs gained in the case of no screening. Probabilistic sensitivity analysis highlighted the reduction of uncertainty in the screening option. Threshold analysis assessed that even with a drop in Chagas prevalence from 3.4% to 0.9%, a drop in the probability of vertical transmission from 7.3% to 2.24% and with an increase of screening costs up to €37.5, "test" option would still be preferred to "no test". The current study proved Chagas screening of all Latin American women giving birth in Spain and of their infants to be the best strategy compared to the non-screening option and provides useful information for health policy makers in their decision making process.
authors.affiliation: Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Spain. elisa.sicuri@cresib.cat
authors.forename: Elisa
authors.initials: E
authors.lastname: Sicuri
authors.forename: José
authors.initials: J
authors.lastname: Muñoz
authors.forename: Maria Jesús
authors.initials: MJ
authors.lastname: Pinazo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Posada
authors.forename: Joan
authors.initials: J
authors.lastname: Sanchez
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascon
mesh_terms: D014355:Chagas Disease / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D010274:Parasitology / Q000191:economics* / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D013030:Spain